Current: Vol. 5, Issue 2 April - June, 2008

INFLUENZA SURVEILLANCE IN UGANDA: DO WE REALLY NEED IT?

Juliet Akello

Last year when we first featured an article in this newsletter about our Avian Influenza Pandemic Influenza project (AIPI), little did we know we had triggered off a chain reaction. Colleagues who know I work for MUWRP had a string of questions for me, some of them on the brink of sounding sarcastic! These included why Uganda deemed it necessary to conduct surveillance of a pandemic that has never struck the country, when we should be concentrating on diseases in our backyard such as malaria. With such cynical comments, I became restless and began seriously considering how many other people out there would have similar questions lingering at the back of their mind.

Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These influenza viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated ones including chickens, ducks and turkeys very sick, leading to their death. It has also been found to infect both humans and mammals.
The first known human case of the highly pathogenic H5N1 avian influenza was reported in Hong Kong in 1996. Since then, the most recent WHO statistics indicate that out of a total of 368-recorded human cases, 234 were fatal. This is a whooping 64% fatality rate! More than 10 years later it is still killing people and crippling the poultry industry in many countries.
It is not yet clear how the virus crosses from birds to mammals and humans. Some cases like the one in 10 patients in Vietnam point to close contact with infected poultry as a source of infection.

Others show mammals being infected by feeding on infected birds, some domestic, others wild. There are also cases such as one in Thailand in
2005 where humanto- human transmission cannot be ruled out. All
this causes great fear that once the epidemic enters a country’s birds, it could eventually start infecting and killing humans.

Ladies and gentlemen, there is a saying that “fore warned is fore armed”. When MUWRP in collaboration with other partners decided on establishing an influenza surveillance system, it was out of the need to detect this deadly virus early and hopefully delay its spread. This will help in not only protecting people’s lives by curtailing infection but also go a long way in helping reduce costs, medical or otherwise that would arise in the event of an outbreak. Experiences from the Ebola outbreaks have enabled us appreciate the challenges faced by resource poor countries such as Uganda in trying to contain epidemics which, if given the opportunity, would have otherwise been averted. It is therefore upon such sentiments that the AIPI project was initiated. It aims to conduct surveillance for influenza and influenzalike viruses in Uganda in order to improve the monitoring of circulating strains as well as identify new emerging strains that may require immediate response.

Initially, two surveillance sites for human cases will be established in Mulago and Kayunga hospitals but more sites will be added with time. The study sites proposed for non-human cases will be Western Rift Valley lakes covering Queen Elizabeth Conservation Area and Murchison Falls National Park, lake Victoria Region covering Eastern, Central and Southwestern lake
shorelines, lake Mburo and the Sango Bay area and eastern Uganda wetland sites covering lake Kyoga Region including lakes Opeta and Bisina
as well as two eastern Uganda Rice Schemes in Kibimba and Doho.
In the beginning, samples collected from suspected human cases will be received at the newly MUWRP-rehabilitated Biosafety level 2 (BSl2) laboratory at Faculty of Veterinary Medicine (FVM). This laboratory was handed over by the contractors to MUWRP management on 21st Jan 2008. Once a second BSl2 laboratory at the Uganda Virus Research Institute (UVRI) in Entebbe is ready, the human samples will henceforth be received
there while non-human samples will be received in FVM.

The project has hired and trained laboratory technologists on techniques to be used in the detection and characterization of the influenza/ influenza-like viruses, and is in the process of installing all the required equipment for the study. MUWRP is therefore well ahead in preparing for a possible pandemic influenza. While we pray that no cases are ever found in Uganda, this surveillance should help us catch it in time to institute appropriate control measures.